More than 25 years into the democratic dispensation, SA has yet to provide a comprehensive healthcare package to all its people.

In the Eastern Cape, the implementation of access to quality healthcare is inhibited by poor or no infrastructure.

Where the government has attempted to bridge the gap between communities and primary healthcare facilities through the distribution of mobile clinics, these clinics are not reaching the communities they are supposed to serve and members of the population, who live more than 5km from a hospital or clinic, still do not have access to primary healthcare services.

Healthcare is an affirmed right. Section 27 of the constitution guarantees this right and places an obligation on the government to take legislative and other measures to progressively realise this right – within its available resources.

The Eastern Cape Department of Health (ECDoH), in the year of the sixth administration, must ensure that this right is realised. This must be done by exercising sound financial administration, through a clear outline of their strategic plans and through a continued analysis of any failures to achieve their strategic plans, more so if they lead to service delivery failure. Lack of accountability and public engagement are examples of poor transparency. If the right to healthcare services is the difference between being healthy and being free from disease and incapacity, then lack of access to healthcare services must be acknowledged as one of the greatest barriers of entry into the healthcare system. Without access to healthcare services, there is reduced or no:

• HIV/Aids, TB education;

• HIV and TB testing;

• Early detection of HIV and TB, treatment and care;

• Retention of patients treatment and care;

• Data collection, capturing;

• Decrease in the number of maternal and child mortality;

• Emergency medical services that arrive on time;

• Medication in facilities;

• Capacity in hospitals and clinics resulting in people traveling long distances and sleeping on hospital floors so they are first in line the next day.

If health is a human right, lack of access to it is a grave breach, one that cannot be allowed to continue. on

The ECDoH received an appropriation of R23.7bn for the 2018-19 financial year. The department’s budget allocation was adjusted to the amount of R24bn with a further projected estimate of R24.5bn. In the 2017-18 financial year and in the department’s third quarter, the department had spent an amount of R5.9bn.

By the end of the fourth quarter, the department had failed to utilise the entirety of its allocated budget. The Department is recorded as having spent R6.1bn in the third quarter of the 2018-19 financial year, 2% more than it spent in the third quarter of 2017-18.

It is unlikely that the department will spend the entirety of its revised estimated budget by the end of the fourth quarter according to its spending patterns. This may result in further underspending by the department, which may result in the inability of the department to spend its budget effectively, efficiently or appropriately.

The effectiveness and efficiency with which the ECDoH spends its budget must be maximised through sound public financial management, something the ECDoH is entitled to request assistance with the provincial Treasury.

Funds for health need to be effectively allocated, executed and accounted for to ensure the budgeting process does not hinder healthcare objectives.

In the Eastern Cape Provincial Development Plan, the Premier outlined critical health system challenges.

These include a dysfunctional health system, socioeconomic conditions, limited financial resources and poor management, dilapidated health infrastructure along with the rural conditions of the province and inaccessibility in some areas, which leads to difficulty in providing healthcare services.

It is concerning that four years after this provincial development plan was introduced, many of the challenges faced by the health system have not changed. To the contrary – some have worsened.

Primary healthcare is the closest link to the community from and as such, the best avenue to respond to the healthcare needs of the community in preventing ill-health. The Eastern Cape has the second lowest primary healthcare expenditure with Limpopo having the lowest.

To improve primary healthcare to overcome the challenges outlined in the provincial development plan, there needs to be an improvement in the equity and efficiency of resources.

As mentioned above, access includes the right to emergency healthcare services that arrive on time. During the 2017-18 financial year, the Eastern Cape Department of Health reported that the Emergency Medical Services programme had spent R1.3bn, 99.9% of its budget for emergency transportation but failed to reach their target to respond to emergencies under 40 minutes in rural areas, the areas that need them the most.

In planning and budgeting for the EMS programme, it is imperative that the ECDoH to take into consideration factors such as population migration, the number of children born, and the standard for emergency medical service ambulances outlined in the 2017 emergency medical service regulation.

The province needs an adequate number of EMS ambulances and staff to ensure that no one is denied EMS services.

During his 2019 State of the Nation address, President Cyril Ramaphosa informed the nation that the NHI detailed plan of implementation is in a stage of advanced revision.

During this time, it is incumbent on the ECDoH to create platforms to disseminate information surrounding the NHI Bill and what it will mean and to what extent it will affect the citizens in the province.

We acknowledge this ECDoH, inherits a state of healthcare in crisis and that they bear a heavy duty of creating institutional frameworks to address this in hopes of making it more equitable to all.

All departments and public officials tasked with the delivery of services in the sixth administration must fulfil their mandates in close collaboration with the beneficiaries of these services.

Accountable governance within a participatory democracy requires inclusive, reflexive and responsive institutions.

By the end of the fourth quarter, it failed to use its allocated budget